<div><?php echo $this->session->flashdata('usuario');?></div>
<div id="titulo">Datos OutBound</div>
<?php echo form_open('outbound/save', array('name' => 'addusuarios','id' => 'commentForm'));?>

 <table class="tablaform" width="100%" border="0">
 <tr>
 <td><b>Nombre Afiliado</b></td>
 <td><input type="text" name="nombre"  class="required" value="" size="50"/>
 <?php echo form_error('referencia');?>
 </td>
 </tr>

 <tr>
 <td><b>Telefono Afiliado</b></td>
 <td><input type="text" name="telefono" class="required" size=20"/></td>
 </tr>
 
  <tr>
 <td><b>Telefono2 Afiliado</b></td>
 <td><input type="text" name="telefono2" size="20"/></td>
 </tr>
 
 <tr>
 <td><b>Fax Afiliado</b></td>
 <td><input type="text" name="fax" size="20"/></td>
 </tr>
 
 <tr>
 <td><b>Email Afiliado</b></td>
 <td><input type="text" name="email" class="email" size="50" value=""/></td>
 </tr>
 
  <tr>
 <td><b>Web Site</b></td>
 <td><input type="text" name="web" class="url" size="50" value=""/></td>
 </tr>

 
  <tr>
 <td><b>Tipo de Afiliado</b></td>
<td>
<select name="tafiliado" id="responsable" class="required">
<option value="">Seleccione un tipo</option>
<?php
foreach ($afiliado as $k)
{
?>
	<option value="<?php echo $k->getIdCategoria(); ?>"><?=$k->getNombreCategoria();?></option>
<?php	
}
?>
</select>
</td>
</tr>

  <tr>
 <td><b>Direccion:</b></td>
 <td>Calle:<input type="text" name="calle"  size="20" value=""/>&nbsp;&nbsp;&nbsp;Sector:<input type="text" name="sector" size="35" value=""/></td>
 </tr>
 
 <tr>
 <td><b>Referencia Direccion</b></td>
 <td><input type="text" name="dir"  size="80" value=""/></td>
 </tr>
 
  <tr>
 <td><b>Provincias</b></td>
<td>
<select name="provincia" class="required">
<option value="">Seleccione un provincia</option>
<?php
foreach ($provincia as $k)
{
?>
	<option value="<?php echo $k->GetIdProvincia(); ?>"><?=$k->GetNombre();?></option>
<?php	
}
?>
</select>
</td>
</tr>

  <tr>
    <td><b>Fecha Proxima LLamada</b></td>
 	<td><input id="date" name="date"><script type="text/javascript">
  	$(function()
  	{
     	 $("#date").datepicker({ minDate: new Date() });
  	});
	</script>
	</td>
    </tr>
 
 <tr>
 <td><input type="submit" value="Agregar Outbound" align="center"/></td>
 <td><a href="<?php echo site_url().'/outbound' ?>"><input type="button" value="Atras" align="center"/></a></td>
 </tr>
 </table>